What Is Menopause?

Menopause is a normal part of a woman's life. Often called "the change of life," it refers to that point in time when a woman's menstrual periods have stopped. Perimenopause is the time of transition leading up to a woman's final menstrual period; it involves a series of bodily changes that can take from one to several years. Once your body has completed these changes, and you have not had your period for 12 months in a row, you have passed through menopause.

Women usually experience menopause between the ages of 38 and 58; the average age is 51. There is some evidence that women living with HIV (HIV+) may experience menopause earlier than HIV-negative women. There is also some evidence that the symptoms of menopause may be more intense for women living with HIV, but there is no definitive proof of this.

The changes of menopause begin when your ovaries (female reproductive organs containing eggs) naturally begin to slow down production of the female sex hormones, estrogen and progesterone. When you near menopause, estrogen levels drop. You stop having regular cycles and eventually you can no longer get pregnant.

Symptoms and Conditions Related to Menopause

A woman can usually tell she is getting close to menopause because her periods start changing. During this time, hormone levels rise and fall unevenly, and she may experience symptoms such as:

Increasingly irregular periods:

Change in frequency (how often)

Change in duration (how long)

Change in amount (lighter or heavier)

Hot flashes

Night sweats

Mood swings

Depression

Irritability

Vaginal dryness

Forgetfulness

Trouble sleeping

Fatigue (extreme tiredness)

Lack of sexual desire

Skin changes including: thinner skin, wrinkling, and acne

Health care providers may think that women living with HIV who experience sweats at night have menopause-related hot flashes, when in fact their sweats may be caused by HIV. Vaginal dryness can be mistaken for a yeast infection. It is important to keep track of your cycles and report any changes to your health care provider. This helps avoid a wrong diagnosis or hormonal treatments that may not be necessary. For more information about menstrual problems and HIV, see our fact sheet on Menstrual Changes.

Women living with HIV may experience changes in their menstrual cycles even if they are not going through menopause. Talk to your health care provider if you are having any of the symptoms described above to find out if they are related to HIV, menopause, some combination of the two, or another condition. It may be helpful to have your hormone levels checked as well.

There are also some serious medical concerns that can develop after menopause, including:

Osteoporosis (bone loss)

Cardiovascular (heart) disease

Urinary incontinence, including more frequent urination or involuntary loss of urine (leaking)

Hormone Replacement Therapy (HRT)

Many women want to replace the estrogen that their body is no longer making because such a replacement relieves the symptoms of menopause. However, taking estrogen without progesterone increases the risk of uterine cancer. If a woman has had her uterus (womb) removed, she can take estrogen by itself. This is called estrogen replacement therapy or ERT. Women who still have a uterus usually take a combination of estrogen and progesterone. This is called hormone replacement therapy (HRT).

Although HRT used to be regularly recommended to relieve menopausal symptoms and reduce bone loss, long-term use of HRT is now questioned. Research has shown that HRT can increase women's risk for breast cancer, heart disease, and stroke. HRT may be appropriate for a short time to relieve menopausal symptoms that cannot be relieved with other treatments. Estrogen and progesterone are available in patches, creams, and vaginal rings; these may be an alternative to the pill form of HRT and may not carry the same risks.

To figure out if HRT is right for you, talk with your health care provider about all of the risks and benefits. Make sure your health care provider knows about any prescription medications, street drugs, over-the-counter medications, alternative therapies, or other treatments you are taking before you decide whether to take HRT.

Sometimes, HIV drugs can reduce the effectiveness of hormones, including birth control pills that contain estrogen and progesterone. Estrogen can also cause lower levels of HIV drugs and put you at risk for a rising viral load and HIV drug resistance. Generally, however, women living with HIV and taking HIV drugs find that birth control pills and other hormonal contraceptives work well. See our fact sheet on Hormones and HIV for more information.

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This article was provided by The Well Project. Visit The Well Project's Web site to learn more about their resources and initiatives for women living with HIV. The Well Project shares its content with TheBody.com to ensure all people have access to the highest quality treatment information available. The Well Project receives no advertising revenue from TheBody.com or the advertisers on this site. No advertiser on this site has any editorial input into The Well Project's content.

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